title: The impact of abnormal muscle tone from hemiplegia on reclining wheelchair positioning: a sliding and pressure evaluation.
abstract: BACKGROUND
  Little is known about the influence of existing muscle tone abnormality on the sitting posture of stroke patients in reclining wheelchairs.
  
  
  OBJECTIVE
  To investigate the impact of muscle tone abnormality from hemiplegia on the forward sliding and pressure of stroke patients while sitting in reclining wheelchairs.
  
  
  METHODS
  Experimental study.
  
  
  METHODS
  The Assistive Devices/Technology Center at the Rehabilitation Department of hospital.
  
  
  METHODS
  14 able-bodied elders and nonambulatory elderly stroke patients with flaccid (N.=12) or spastic hemiplegia (N.=13) participated in this study. Of the 12 patients with flaccid hemiplegia, 8 suffered from left-sided hemiplegia and 4 from right-sided hemiplegia. Of the 13 patients with spastic hemiplegia, 6 suffered from left-sided hemiplegia and 7 from right-sided hemiplegia.
  
  
  METHODS
  We performed 3 reclining cycles in wheelchairs with conventional seats and V-shaped seats for each participant. The sliding along the backrest (BS) plane and the seat (SS) plane, mean sitting pressure (MP), and sacral peak pressure (SPP) of the participants were recorded. The Kruskal-Wallis test was used to compare the difference in BS, SS, MP, and SPP between able-bodied elders and stroke patients.
  
  
  RESULTS
  The BS, SS, and SPP during repetitive reclining were generally greatest in flaccid hemiplegic participants, followed by spastic hemiplegic participants, and finally by able-bodied participants. There was no significant difference in MP among three subject groups on both conventional seats and V-shaped seats in most comparisons. Able-bodied participants' buttocks tended to slide forward on conventional seats but backward on V-shaped seats, whereas hemiplegic participants' buttocks slid forward on both seat types.
  
  
  CONCLUSIONS
  Stroke patients with flaccid hemiplegia are the most vulnerable to sacral sitting and higher sacral pressure in reclining wheelchairs, followed by patients with spastic hemiplegia. There is a difference in the displacement pattern between participants with normal muscle tone and those with abnormal muscle tone during wheelchair positioning. People who have hemiplegia with spasticity do not have incremental forward sliding with repetitive reclining in the same way as those who have a flaccid hemiplegia.
  
  
  CONCLUSIONS
  The findings are valuable for wheelchair prescription and caregiver education.
authors.affiliation: Department of Physical Medicine and Rehabilitation Chia-Yi Christian Hospital, Chia-Yi, Taiwan - 03281@cych.org.tw.
authors.forename: H C
authors.initials: HC
authors.lastname: Huang
authors.forename: Y S
authors.initials: YS
authors.lastname: Lin
authors.forename: J M
authors.initials: JM
authors.lastname: Chen
authors.forename: C H
authors.initials: CH
authors.lastname: Yeh
authors.forename: K C
authors.initials: KC
authors.lastname: Chung
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004867:Equipment Design / Q000009:adverse effects / Q000592:standards; D005260:Female; D006429:Hemiplegia / Q000209:etiology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009122:Muscle Hypertonia / Q000209:etiology / Q000534:rehabilitation*; D009123:Muscle Hypotonia / Q000209:etiology / Q000534:rehabilitation*; D056888:Patient Positioning / Q000379:methods* / Q000592:standards; D011187:Posture / Q000502:physiology; D003668:Pressure Ulcer / Q000209:etiology / Q000517:prevention & control; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation; D013624:Taiwan; D014910:Wheelchairs / Q000009:adverse effects* / Q000592:standards